Evaluation of the Diagnostic Criteria of Internet Addiction/Problematic Internet Use Among U.S. University Students: A Mixed Methods Evaluation

Background and Purpose: Internet addiction/problematic Internet use (IA/PIU) is increasingly prevalent worldwide (Moreno et al., 2011).  Internet users meeting criteria for IA/PIU evidence significantly higher levels of major depression, social and somatic anxiety disorders, social isolation, peer and parental relationship dysfunction, school/work problems, and health problems such as sleep deprivation and obesity than their non-IA/PIU counterparts (Bernardi & Pallanti, 2009; Young, 1998).  Only one type of IA/PIU (i.e., Internet Gaming Disorder) was included in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5, Section III); however, there has been a call for further research on other IA/PIU disorders (American Psychological Association, 2013).  In response to this inquiry, this study was developed to explore the degree to which IA/PIU behaviors described by university students fit the DSM-5 substance use disorders criteria.

Methods: Mixed methods were employed for this evaluation.  Participant recruitment was conducted using purposive sampling.  University students who self-identified as Internet addicts were invited to participate through a recruitment email.  In total, 4 semi-structured focus groups were conducted, and 27 students (17 women, 10 men) participated.  A semi-structured interview guide consisting of 24 subjective open-ended questions was used to facilitate focus groups.  Focus groups were audiotaped, transcribed, and checked for accuracy.  Transcripts were independently analyzed by three separate members of the research team using a content analysis approach.  An objective measure (Young’s Diagnostic Questionnaire) was used to assess the symptoms of IA/PIU.

Results: Almost all participants (96%) reported staying on-line longer than originally intended, with 74% having experienced unsuccessful efforts to control or cut back Internet use.  Participants reported substantial overlap between their own experiences with Internet use and DSM-5 substance use disorders criteria.  Specifically, eight of 11 diagnostic criteria for substance use disorders in DSM-5 were reported.  These criteria included: a) salience (5-16 hours spent on the Internet for non-school/work-related activities per day), b) withdrawal, c) persistent desire or unsuccessful efforts to cut down or control Internet use, d) staying on the Internet over a longer period than intended, e) craving, f) recurrent Internet use resulting in failure to fulfill major obligations at work or school, g) social and recreational activities given up or reduced because of Internet use, and h) Internet use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by IA/PIU.  The criteria of tolerance and recurrent Internet use in physically hazardous situations were not reflected in the qualitative data.  The effects of IA/PIU on social activities and interpersonal relationships were mixed.  Detailed information about findings will be presented including the results of Young’s Diagnostic Criteria, participant quotes for each criterion, and clinical significance.

Conclusion and Implications: This is one of the first studies to compare DSM-5 substance use criteria to Internet use in the United States.  Findings suggest that the symptoms of IA/PIU are similar to substance use disorders. Therefore, the DSM-5 substance use disorders criteria could serve as a foundation to develop diagnostic criteria for IA/PIU.